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The nutritional quality of individual items offered with kids' meals improved at some restaurants, but less than 1% of the 5,427 kids' meal combinations met recommended nutrition standards.

There was a 54% increase in the number of possible kids' meal combinations available in 2013 compared with 2010. However, there was no change in the number of combinations that qualified as healthy meals for elementary school-age children.

Only 3% of kids' meal combinations met the food industry's own revised CFBAI nutrition standards or the National Restaurant Association's Kids LiveWell standards.

Children and teens eat an extra 126 and 310 calories, respectively, on days they eat fast food. Fast food consumption also increases the intake of sugar, saturated fat, sodium, and sugary drinks.

On average, U.S. preschoolers viewed 2.8 fast food ads on TV every day in 2012, children (6-11 years) viewed 3.2 ads per day, and teens viewed 4.8 ads per day.

Six companies were responsible for more than 70% of the TV ads seen by children and teens in 2012.

The total number of TV fast food ads seen by children ages 6 to 11 decreased by 10% between 2009 and 2012, but there was no change in the number of ads seen by children ages 2 to 5.

The majority of fast food restaurants stepped up their TV advertising to children. Among the top-25 advertisers, 19 increased advertising to preschoolers and 14 increased ads to older children

McDonald's remained the only restaurant to advertise more to children than to teens or adults on TV.

McDonald's placed a total of 34 million display ads for Happy Meals on websites each month, a 63% increase from 2009. Three-quarters of these ads appeared on kids' websites like Nick.com, Roblox.com, and CartoonNetwork.com.

Healthier kids' meals were advertised, but represented only one-quarter of fast food ads viewed by children on TV.

Teens saw as many or more TV advertisements for Taco Bell, Sonic, and Starbucks than adults, although teens watch 30% less TV�thus these restaurants likely targeted their ads specifically to adolescents.

Between 2009 and 2012, fast food restaurant likes and followers on Facebook and Twitter increased between 200% and 6,400%. Six fast food restaurants each have more than 10 million likes on Facebook.

Fast food restaurants continued to target black and Hispanic youths, populations at high risk for obesity and related diseases.

Black and Hispanic youth were more likely than their white and non-Hispanic peers to visit one-third or more of all fast food websites. For instance, Hispanic youths were 30% more likely to visit HappyMeal.com, while black youths were 44% more likely to visit.

Fast Food FACTS in Brief

In 2010, researchers at the Yale Rudd Center for Food Policy & Obesity issued Fast Food FACTS. The report examined the nutritional quality of fast food menus, fast food advertising on TV and the internet, and marketing practices inside restaurants. Researchers found that the industry spent $4.2 billion on advertising to encourage frequent visits by young people to fast food restaurants, targeting children as young as two years old.

Three years after our first report - using the same methods as the original Fast Food FACTS - this report quantifies changes in the nutritional quality of fast food and how it is marketed to children and teens. These analyses focus on 18 fast food restaurants.

NUTRITION

Despite the addition of some healthy kids' meal options, less than 1% of all kids' meal combinations - 33 out of 5,427 possible meals -- met recommended nutrition standards.

Most restaurants offered at least one healthy side option and three-quarters increased healthy beverage options and McDonald's changed Happy Meal sides to automatically include half-portions of french fries and apples.

The number of possible kids' meal combinations increased 54%, but there was no change in the number of combinations that qualified as healthy meals for elementary school-age children.

Only 3% of kids' meal combinations met the food industry's own revised CFBAI nutrition standards or the National Restaurant Association's Kids LiveWell standards.

Although the number of regular menu items offered increased dramatically, the proportion of healthy menu items remained the same.

Less than one-quarter of restaurants' regular menu items qualified as nutritious options for teens.

Restaurants continued to offer large or extra-large soft drinks (350-850 calories) and large french fries (470-610 calories).

MARKETING TO CHILDREN AND TEENS

In 2012, fast food restaurants spent $4.6 billion in total on all advertising, an 8% increase over 2009. For context, the biggest advertiser, McDonald's, spent 2.7 times as much to advertise its products as all fruit, vegetable, bottled water, and milk advertisers combined.

McDonald's display ads for Happy Meals increased 63% to 31 million ads monthly. Three-quarters appeared on kids' websites, such as Nick.com, Roblox.com, and CartoonNetwork.com.

There were some positive trends in fast food marketing to teens but restaurants continued to target them with TV and internet marketing for primarily unhealthy products.

TV ads viewed by teens did not change, but average calories per ad viewed declined by 16%.

Teens were more likely to see more TV ads for Taco Bell, Sonic, and Starbucks compared with adults.

Display ads on youth websites declined by more than half, from 470 million monthly ad views per month in 2009 to 210 million in 2012. However, KFC, Subway, and Starbucks more than doubled display advertising on youth websites.

Fast food marketing via mobile devices and social media popular with teens has grown exponentially.

Six billion fast food ads appeared on Facebook - 19% of all fast food display advertising - including more than half of Dunkin' Donuts' and Wendy's ads.

Smartphone apps offer interactive features such as order functions and special offers.

Fast food restaurants continued to target black and Hispanic youth, who face higher risk for obesity and related diseases.

Black and Hispanic youth were more likely than other youth to visit one-third or more of all fast food websites

RECOMMENDATIONS

Over the last three years, there have been some improvements to the nutritional quality of fast food, and to companies' marketing practices. However, the pace of improvement is slow and unlikely to reduce young people's overconsumption of high-calorie, nutritionally poor fast food.

Fast food restaurants should do more to improve the nutritional quality of kids' meals and regular menu items

Apply industry standards for healthy kids' meals to the majority of kids' meal combinations available for purchase - not a mere 3%.